Prevention of infective endocarditis in developing countries

Prevention of infective endocarditis associated with dental interventions: South African Heart Association position statement, endorsed by the South African Dental Association

“…Regrettably, this has not happened. (2) The rationale for antibiotic prophylaxis is based on the assumption that bacteraemia subsequent to medical procedures may cause IE, particularly in those with predisposing cardiac disease. P rophylactic antibiotics might prevent IE by minimising bacteraemia, or by altering bacterial properties leading to reduced adherence to the endocardium.…”

“…P rophylactic antibiotics might prevent IE by minimising bacteraemia, or by altering bacterial properties leading to reduced adherence to the endocardium. (1,2,12) This concept led to the recommendation of antibiotic prophylaxis in a large number of patients with predisposing cardiac conditions, undergoing a wide range of procedures.…”

“…Assumptions are based on non-uniform expert opinion, findings from animal models, case reports and contradictory observational studies. (1)(2)(3)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) In the majority of those who suffer IE, no potential index procedure can be identified beforehand. The estimated risk of IE following dental procedures is very low.…”

“…Eliminating gingivitis would reduce the incidence and degree of spontaneous bacteraemia and hence IE. (1)(2)(3)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Oral health in South Africa is generally quite poor and addressing this at policy level will have more impact on the prevalence of IE than antibiotic prophylaxis. (2) A recent SA study concluded that inadequate attention is paid to the maintenance of oral hygiene in patients with severe rheumatic heart disease (RHD) requiring cardiac surgery.…”

“…(1)(2)(3)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Oral health in South Africa is generally quite poor and addressing this at policy level will have more impact on the prevalence of IE than antibiotic prophylaxis. (2) A recent SA study concluded that inadequate attention is paid to the maintenance of oral hygiene in patients with severe rheumatic heart disease (RHD) requiring cardiac surgery. (22) All Expert Committees on IE prevention agree that the maintenance of optimal oral hygiene (by regular professional dental care and the appropriate use of manual, powered and ultrasonic toothbrushes, dental floss and other plaque-removal devices) is the most effective intervention for the prevention of IE of oral origin.…”